It is a heart-wrenching experience to watch your child developing a substance abuse. There is no magic word or mantra that would change everything, but here is what we know so far:

Maintaining connection is crucial

Teens know that drugs and alcohol can be dangerous; and scaring them with statistics does not work well

Parents need to work hard, be patient and consistent to help their kids with substance abuse

You can use all the help you can get

You need to start somewhere; and the first step is to start a conversation and listen.

These are few tips that can help you start the conversation about substance abuse. This article is the courtesy of DrugRehab.com, a top-ranked web resource provided by Advanced Recovery Systems. And their mission is to equip patients and families with the best information, resources, and tools to overcome addiction and lead a lifelong recovery.

By Tyler Bohlman

How to Talk to Your Teen about Substance Abuse

If you think your teen has a problem with substance abuse, the first step is to talk with them about it. But this task is much easier said than done. How do you know what to say? How do you start? Here are a few steps you can take to have the best conversation you can about drugs.

Confront, Don’t Accuse

The most important part of this conversation is your attitude toward it. You are confronting your teen about their problem with drugs, but the last thing you want to do is make an already difficult conversation worse. You don’t want to come at them like a tornado, yelling about how disappointed you are in them, how they let you down, etc. Instead, come at them with a firm, concerned tone. This allows you to maintain a presence with them as the adult, but it doesn’t immediately put them on the defensive. Remember, this conversation needs to be about them, not you. Let them know any past actions are forgiven; you are only looking forward from here.

Don’t Jump to Conclusions or Solutions

Fight the temptation to immediately play the blame game. Blaming their friends or important figures in their life will only anger your teen. This conversation may finally give them the opportunity to speak their mind to you about the hardships in their life; listen to what they have to say. Don’t hear a problem and immediately jump in with a solution, let them vent and ask follow-up questions and give them a chance to figure out the solution themselves. Even if the solution is obvious to you, it may not be to them.

Listen to What They Say

Rarely do teens abuse substances without an underlying cause behind it. So when you’re told the reason behind your teen’s drug use, you need to listen — even if the problem is you. No matter what the problem is, or how silly it may seem to you, it’s very real for them and finding the root cause of the drug problem is the first step to solving it.

Find a Good Time and Place to Talk

It may feel like no time is the right time to confront your teen about their drug use, but the sooner you have this conversation, the sooner you can fix the problem. It’s up to you to decide the perfect time to talk with your teen, but here are some tips to finding the right time and place to talk:

Make sure they aren’t using at the time: Figure out when your teen uses their substance and work the conversation around that. This will make them more honest with you and cause them to face their problem without the crutch of their substance of choice.

Don’t set a time limit: A busy schedule can kill this concept pretty quickly, so try to have this talk when everybody is in once place for an extended period of time. The last thing you want to do is rush the conversation and not hit on all the topics that are needed to make it worthwhile.

Find an appropriate place to talk: A conversation as serious as this should happen privately, but this doesn’t mean you have to talk at home. Many parents feel a car ride to school or home from the mall is an appropriate time to talk. If you do choose your home, the dinner table, living room, basement or even their bedroom will work.

The First Conversation Isn’t Necessarily the Last

It would be great to say that if you follow these tips your conversation will happen wonderfully; your teen will open up to you, spill their hearts, and immediately give up drugs. Unfortunately, this isn’t usually the case. Your teen’s first reaction will be to deny their drug use, but don’t let this discourage you! If they are showing signs of anger, or beginning to shut down, end the conversation. Tell them that you are bringing this up because you love them, and you are ready to talk whenever they are. This lets them know you care, and you are planting seeds for future conversations.

There is no right way to have a conversation with your teen about their drug or alcohol use. The best you can do is figure the most effective ways to communicate with your teen and get your teen to respond to you the best. Pair these tips with your own communication techniques to start your teen on the road to recovery.

Winter holiday times are joyful for most of families but for parents of troubled teens they are often full of anxiety, grief, and fear. We look at happy pictures of ‘normal’ families, read and hear about their joy and anticipation, and we wonder: why not me? What have I done to deserve it? Can’t we enjoy just these few days like ‘they’ do? These are the days when online support groups for parents of struggling kids get many postings. Some parents share their desperation and pain, some ask for advice or just look for kind words of support. I know that pain, grief, and desperation. It often makes us feel lost, defeated, and hopeless. It is OK to spend some time wallowing in it, but then we have to remember that we are parents, and it means we never stop fighting for our kids. Start owning it. We are not the ‘normal’ families, this is our reality, we need to accept it and deal with it. Sit down and try to figure out the situation. Think back one year and compare what you have today with what you had then. Sometimes one tantrum about gifts, privileges, grades that your kids throw around this time can make you feel that all is bad. Try to be as objective as you can. Assess their environment: friends, influences, how they spend time and what is ‘normal’ for them. Assess your family relationship. Is there communication? Who is in control and in what situations? What works and what does not? Take into account any progress: has it been for the better or for worse? What about drugs, alcohol, self-harm, abuse? The bottom line, this assessment can help you understand the dynamics in perspective. Think about yourself: are you better at handling the situation, worse, or no change? When you have a more or less clear picture of where you are, take a break and return to it again in a day or two. Talk to someone close who knows your situation and listen to their input. Then is a good time for The New Year Resolution. If you lost control, you can think about how to regain it. Parenting classes make huge difference. Parents who chose to join such classes generally feel like they gain control over their lives. They learn tools, see patterns and directions. If you need support, it is time to start actively looking for it. Online groups are good to supplement real communities. There are churches, community and therapy groups, mental health networks, support groups for families with addiction and self-harm… Start looking and don’t stop until you find what you need. Think how you can take better care of yourself and start right now. Yoga or meditation, movies with friends, book club or that hobby you never had time for – the time is now. By showing your children that taking care of yourself is important you set a valuable example. If you see that your situation is getting worse and your child is rapidly heading for a disaster, stop looking for band aids and start looking for long-term solutions: rehabs, programs, living arrangements, therapy… Talk to several specialists, make a plan, and follow it. Parenting a struggling teen is one of the hardest tasks. But even if you feel that there is no hope for you, there is a strong chance you might be wrong. I know of many teens’ lives turned around. Take time and assess your situation, make a plan, and start with small steps. This means taking control, fighting for your child. We are not likely to become ‘them,’ the normal happy families smiling at us from billboards and TV screens. Many people around us won’t understand our struggles, but hiding in the dark and pretending that all is well will not help. May your New Year’s Resolution become your turning point so that in one year time you will look back and think: I cannot believe the progress we have made!

What does it take for kids who struggle with destructive behaviors to change their lives? This is a question every parent of a struggling teen asks. Depression, anxiety, active drug use, and violent outbursts seem like impossible challenges to overcome. A recent National Public Radio (NPR) segment by Alix Spiegel, “What Heroin Addiction Tells Us About Changing Bad Habits” got us thinking.

The report describes how a group of heroin addicted servicemen about to return home from Vietnam were kept there until they dried out. After returning to the U.S., about 95% of them stayed drug-free for the 1st year. This is in striking contrast to present day statistics where only about 10% of people stay ‘clean’ after completing rehab programs. So, how was this possible? What helped these soldiers to overcome their addictions?

Upon returning to the U.S., the soldiers were no longer living in an environment in which the habit of drug use was a part of their daily routine. With a disruption to the environment, behavior change followed. When addicted individuals complete rehab and return to the same environment, the likelihood of a return to past drug using behavior is high. Social scientists have long argued that providing treatment in a vacuum, without also “treating” the environment to which the person is returning is a recipe for certain relapse. The addicted individual, the family and the community must all be engaged in order to affect lasting change.

According to Wendy Wood, a behavioral psychologist cited in the NPR piece, “in the 1960s, 1970s and 1980s scientists thought that if you wanted to change behavior, the key was to change people’s goals and intentions.” New research invalidates the idea that goals and intentions alone are enough to affect lasting behavioral change, especially when the unhealthy behavior has been repeated a lot. Another behavioral psychologist, David Neal, further explains that behavior doesn’t necessarily follow intention, which is why even when struggling kids want to change, they often have such a hard time doing so. Disrupting the environment, and practicing the new, healthy behavior in a different setting is a more likely catalyst for lasting change.

But changing the setting doesn’t necessarily mean the teen has to leave his or her home or current school. Even small shifts in the environment can lead to healthy changes in behavior. This is good news for kids who seek change but lack the skills to make it happen. By engaging with motivated kids to understand the factors that impede change, parents can help adjust the environment to promote success. For instance, is social media getting in the way of homework completion? Is lack of sleep affecting school performance? Is peer pressure causing anxiety? Setting limits on phone access, renegotiating bedtime routines and providing education about positive peer relationships may do the trick.

But what does this mean for kids who lack intention or motivation to change their lives? What can parents do to promote behavior change?

Here are some thoughts:

If we want to change, but our environment remains the same, the old destructive patterns will keep undermining our efforts.

We have to consciously build and maintain new behaviors. When bad habits have been repeated a lot, new healthy behaviors need to be practiced a lot.

Change is not linear. There will be setbacks. Plan fresh strategies for how you will react to the failures as well as the successes.

Engagement in the process of change is critical; threatening your kid is not likely to yield satisfying results. Fear is rarely a good motivator!

Parents (and siblings) are also part of the environment. Helping kids to overcome unhealthy behavior means dealing with our own (and our other children’s) issues head-on.

If you are planning to move to another house, town, or even another country, establish new healthy patterns right away. Don’t wait to start your new life until you are settled or your old behavior will travel with you.

Short-term environmental changes like sending kids to summer camp or an Outward Bound program may be useful in teaching new skills and altering perspective. When kids come home, it is important not to fall into old patterns.

Sometimes, when the environment is too damaging (bad friends, poor family relations, traumatic memories, all resources exhausted) a new physical environment may be necessary. A therapeutic school, wilderness program, treatment facility or another setting may be the environmental shift your family needs in order to realize lasting change.

As a member of several online support groups for parents of struggling teens and young adults, I often read this cry of desperation: “I have tried it all to help my kid! Is it time for me to give up and kick him or her out?”

Here are my thoughts:

The best advice depends critically on your specific circumstances: you, your child, your family, your history, your community and the support and resources available.

How sure are you that you have ‘tried it all’? Without questioning the effort we put into helping our children, I know from personal experience that as parents our thinking tends to be limited to what we know and resources we can easily access.

Schools may have minimal ability and/or motivation to offer new or unconventional help to struggling teens and their families. Yet there are many promising approaches capable of producing good results: restructuring education, using homeschooling resources, engaging kids in extracurricular activities, or finding a teacher who serves as an inspiring role model.

Individual or family therapy can help if and when the personality, treatment model and experience of the therapist fit the needs of the child and family. If your kid goes to see a therapist every week, but refuses to engage, perhaps it’s time to find a new therapist?

Support groups can be lifesavers for both kids and parents by providing a community of likeminded individuals all struggling with similar challenges. Think school-based social skills groups, grief groups, Alateen, AA, NA and Al-Anon, Parents Anonymous, NAMI, or even web-based support. There is nothing worse than feeling alone with your problems.

It is hard to overestimate the effect environment has in motivating kids to find the strength to change. If the home environment has little positive to offer, we might need to look inward to see what changes can be made to restore our family to health. If the community our child lives in does not support healthy behavior, how can we become catalysts for change?

Assessing and changing our parenting. This is a hard one. We often see families with struggling kids managing problems tactically, not strategically. Parents might settle for a day or even an hour of peaceful co-existence at the expense of the long-term development and maturation of their teenager. Whether living in the same household or not, parents need first to get on the same page about goals and expectations for family life and then create a road map for how to get there. (This is where a good therapist can really help!)

Well-intentioned parents too often do things for their children instead of teaching them to do things for themselves. When we believe our children are incapable of doing something on their own, inevitably our children come to believe that about themselves. When we hold up the expectation of personal responsibility, our children are more likely to rise to the occasion. When we bail our children out of the messes they create, we deprive them of valuable life lessons in personal accountability.

Asking relatives and friends for help. Sometimes kids respond better to suggestions, rules, and advice when they come from others who are not their parents. Letting your child stay with a family member or a friend, even temporarily, might allow for a needed cooling off period while tempers settle and a more thoughtful long-term solution is investigated.

Asking around about other local resources. This is area-specific; and you might be surprised to find a great opportunity for your kid just around the corner.

Getting back to the original question, I want to say one thing: asking your kid to leave your house or sending her or him away is not a sign of giving up. Sometimes a teen or young adult needs to learn personal responsibility the hard way; and letting them go is necessary. Placement in a therapeutic school, wilderness program, treatment facility or another setting may be in your, your child’s and your family’s best interest. Sometimes you have to say: enough is enough, but never give up on your child. Let them know that you believe they can do it on their own and don’t stop loving and supporting them.

It is nearly impossible for me to pinpoint when problems with my son began, but I vividly remember the time when his road to recovery started. His problems had accumulated to the point that I was not sure if he would survive another day. He was kicked out of school, angry and defiant, disappointed with life, fuelling himself with drugs, alcohol, and adrenalin wherever he could get it. He ruled my life while I had no control over my own life at home, let alone his actions. I loved him so much; and the pain of seeing the destruction and hopelessness of his everyday existence was unbearable.

All the local resources had been exhausted; and I spent hours, days, and weeks reading all I could about programs and interventions. Some information terrified me: accidents and maltreatment, complaints of parents and traumas of kids. But some were positive and encouraging, giving me a hint of hope. I did a lot of research; after all, I had years of graduate education and good research skills. I looked at my list of pros and cons and realized that every day I am basically gambling with the life of my son, I made a decision and started to act.

I used all the manipulative tricks I could think of to convince my son to get help. Finally, he agreed to go to a wilderness program. It was hard for my husband and me to make him believe that his situation was serious and about to explode in his face, but we did it. I believe that he wanted out, even though he could not admit it to himself. Proud and arrogant, he ignored me all the way to the airport. He was going to show me and the rest of the world that this wilderness thing would be a walk in the park for him. He anticipated a triumphant return in a few weeks time and he looked forward to being showered with everyone’s admiration and respect. I was glad that he did not want to talk: I hung by a thread, clinging to the choice I made, not allowing my mind to second-guess it. Staying in the moment was important. One wrong word, a glance, or move, and he could change his mind. Or I could change my mind. Feeling and thinking locked away until he was on that plane. My face was a mask; my heart was a muscle, nothing more. He did not look back when he went through the security.

I remember the ride home – I felt empty. I did what I did, and I needed to reload. I remember that every few minutes I would ask myself: did I do the right thing? Did I? What else could I have done? What else can I do now? When I got the call from the wilderness program that my son arrived safely and was being enrolled, I started to come alive again. This was terrifying and invigorating at the same time. And then the feelings and thoughts came rushing.

Guilt. I failed as a mother. I could not help my son; I sent him away to be ‘fixed’ to people I don’t even know… Fear. What if something happens to him out there in the wilderness? It is dangerous; and he is defiant and angry. What if he puts himself in danger? What if…? What if he comes back hating me even more? What if this does not work, and he will come to believe that he is unrecoverable? Helplessness. I had no control over the situation whatsoever. All I could do was waiting. No agency, no power…

When I could not stand these feelings for one more heartbeat, I asked my husband to come with me to the café nearby. We got coffee and sat outside looking from a distance at the group of teens who were our son’s ‘friends’. Some seemed high, giggling and “hanging out’, some were arguing and looking ‘cool’. Then we heard an ambulance siren. We looked at each other and realized that for the first time in many months we were not afraid of this sound any more. The ambulance was not rushing to save our son from overdosing, a knife injury, or a car accident. Then slowly, in the coming days, weeks, and months I began to deal with my feelings.

Guilt. I did not fail as a mother. I did not stop fighting for my son. I used all the resources I had to help him. It meant sending him away and reaching out for help from people I did not know. But it had been the right thing to do. Fear. His everyday life back home had many more dangers in it. His lifestyle and life choices were toxic and killing him. Life will always be dangerous; and I needed to accept it. Taking risks was scary, but not taking them was deadly. I learned to embrace my fear and learn from it. Then it stops being paralyzing and becomes an incentive to change. Helplessness. I was not helpless. I continued learning about helping my son, other programs that can help him. I found a great one where he continued his journey. I also had to learn a lot about myself, my damaging patterns of communication and behavior and how to change them. Sending your kid away to be fixed does not work. I had to enter a ‘parallel process’ and take control over my own life. I had to understand when I was enabling, fearful, overbearing, and unaware and learn how to do better. And I had to find people who could help me on this path.

This was more than 3 years ago. My son is now in college. I am happy for him and proud of many things he has done and is currently doing, even though I don’t always agree with his choices. His journey has been his; he was not ‘fixed’ by the wave of a wand or a miracle pill. He worked very hard to get there and is still working hard. But this story is not about him. It is about a Mom and her own journey, my journey. It is hard to send your children away. It is heartbreaking, but sometimes it is the only way to give them a chance. And there are people out there who know how it feels. They are in the struggle together. Find them. I am so lucky that I did.

According to the National Association of School Psychologists, 1 in 11 teenagers today is diagnosed with anxiety severe enough to be considered a disorder; and girls develop anxiety disorders more frequently than boys. This is why we went to visit the Mountain Valley Treatment Center in Haverhill, NH. We wanted to use our combined knowledge of mental health, education, consulting, and evaluation to get a sense of this program and the services it provides. Located in a beautiful country site, with picturesque views of mountains and fields, the program made a strong impression on us. We were hosted by a skilled, highly credentialed team of outstanding specialists who spoke with passion about the work they do and the treatment model they have developed.

For many families, the relationship with the treatment team begins before the client steps foot in the program. The Mountain Valley team frequently travels around the country to meet clients in their homes to explain their services and to begin the process of educating potential clients and their families about disordered anxiety. Mountain Valley utilizes an evidenced treatment modality known as Exposure and Response Prevention (ERP) in which clients are gradually and thoughtfully exposed in a controlled and compassionate fashion to feared objects and situations, followed by a process of reflecting on the experience with their peers in support groups, in therapy sessions with members of the clinical team and in family therapy. The program relies heavily on the use of eight wellness modules: Farm to Table, Forest to Family, Equine Therapy, Mindfulness, Adventure, Fitness, Academics, and Art. The Mountain Valley team also offers comprehensive post-program support planning.

We asked the Clinical Director, Dr. Francis Moriarty to write a piece on anxiety for our blog to help families of struggling teens to better understand this issue. Please, feel free to comment or ask questions.

Anxiety is universal. Everyone gets it. It is a normal, useful, and even critical emotion. It communicates to us through a sense of worry, fearfulness, and alert that danger is near or upon us. Yet sometimes anxiety becomes an exaggerated, unhealthy response.

Adolescence or the teen years are the scene of a constant barrage of pressures and uncertainties. Anxiety, for many, if not all, teens, is a constant companion lurking in the background. For some teens, anxiety becomes a chronic state of daily life, interfering with the ability to attend school, perform to their potential, and participate in the extracurriculars that they have loved in the past. Often times, through avoidance, connections with friends and peers are sacrificed, while at home, domestic calm can be shattered by silence, withdrawal and at times aggression. Sometimes anxiety is characterized by a general, yet pervasive, sense of uneasiness. At other times, the fear and anxiety take the form of panic or fear of specific things or situations.

What to look for: Anxiety disorders take different forms and can vary widely from teen to teen. The presence of an anxiety disorder might be observed first with a general sense of uneasiness. Also, there may be the presence of excessive fears and worries, feelings of inner restlessness, and a consistent presence of apprehension, worry and hyper-vigilance.

Social settings can become occasions for great dissonance. In these situations anxious teens may appear dependent, withdrawn, ill at ease, and extremely avoidant. They may become overtaken with concern over their ability to keep it together or experience hyper-vigilant preoccupation with their ability to interact effectively.

In addition to emotional and behavioral problems, anxiety disorders can also impact a teen’s sense of physical well being. Common issues include: muscle tension, nausea or stomach complaints, headaches, soreness in muscles and joints, fatigue and a sense of lethargy that they believe is disabling. Skin discoloration or blotching, sweating, hyperventilating, trembling and an exaggerated startle response may also be present.

Adolescence is a time of emotional turbulence and upheaval in the best of circumstances. When an anxiety disorder is emerging this turmoil can be exaggerated in many different ways.

An overwhelming sense of intense panic may arise without any noticeable cause. Previously benign situations may take on new energy becoming triggers for a full-blown panic attack, characterized by a sudden episode of intense anxiety accompanied by emotional and physical symptoms. Once an experience of this kind is endured a teen may find that they are living in fear that another such occurrence may arise and that they will be powerless to prevent it.

Research indicates that school avoidance in middle school or junior-high has increased dramatically over recent years. Inordinate worry about performance or social pressure is at the heart of this rising level of truancy. A cycle of anxiety, physical complaints, and school avoidance is thus created and maintained. The pattern becomes exacerbated by increasing frequency and severity of physical complaints followed by visits to health care providers who most often are at a loss to provide concrete medical explanations for the complaints. The longer this pattern is perpetuated the more the fear rises and the harder it becomes to return to school. This leads to a greater sense of isolation and fear resulting in a greater entrenchment of avoidance.

Much of the research has suggested that a predisposition towards shyness and anxiety is prewired from birth. Additionally, if one or both parents have a tendency towards anxiety, there’s a good chance that their child will also have anxious tendencies. The environment, albeit often very loving and supportive, communicated in a family system comprising one or more anxious parents, may compound the child’s natural sensitive inclination. This is fertile ground for the generation of a cycle of increasing uneasiness. By the time this child reaches adolescence, his characteristic way of functioning in the world is consistently informed by a well-developed sense of anxiety. This maladaptive functioning is often supported by the entire family system through a process known as family accommodation. Family accommodation refers to ways in which family members accommodate their child’s symptoms. This can take many forms including providing reassurance, assisting or participating in the avoidance of feared objects or situations, taking over their child’s duties, and changing or modifying family routines. Family accommodation serves to reinforce a child’s anxious response and in so doing increases symptom severity and adversely impacts treatment.

Some teens with anxiety disorders can also become depressed or develop problems with eating. Evidence also suggests that persistent anxiety may lead to suicidal feelings or self-destructive behaviors. These symptoms should not be minimized and require immediate attention and treatment. Sometimes an anxious teen might self-medicate or self-soothe with the use of alcohol and drugs.

It is important to remember that the disturbance and disruption caused by the presence of an anxiety disorder can be effectively managed with education and treatment. A teen can learn skills to minimize the debilitating impact of anxiety and find the competence, skill and energy to face life with hope and confidence.

For some children and teens who struggle with social, emotional, and behavioral issues during the school year, summer can be either a great challenge or a great opportunity. While a low-key and low-stress relaxed family vacation might seem like a good idea to parents, for some kids it can lead to feelings of loneliness and isolation, worsening symptoms of depression and anxiety, and increased acting-out behaviors. Choosing a program just because it ‘gives them something to do’ might be a loss of a great opportunity. What can help is for parents to have a serious look at their child’s challenges and to think strategically. Here are some examples: a child who during the school year has an intense and positive social life with good friends and serious academic work, but who struggles to engage with family might benefit from a family hiking, cycling or canoeing adventure. Parents can make this time most productive if they are mindful of the goal of the vacation: to get closer to each other, to work on trust, to enhance communication and to build family memories. There are some great readings on fine tuning parent listening skills and developing trust with your child, which parents might want to read beforehand (“How to Talk So Teens Will Listen and Listen So Teens Will Talk” by Faber and Mazlish or websites like https://portal.lifeworks.com/portal/viewers/HPSArticle.aspx?HPSMaterialID=5062). Keeping sight of goals and allowing lesser issues to slide, this type of vacation summer can help build a very important foundation for tackling teen challenges in the future.

When you have a child who is struggling with making friends, a small summer program where kids work together on common goals might be very beneficial. There are many programs out there; and assessing your child’s strength and weaknesses will help you find the best fit. Consider whether a specialized camp to learn kayaking, theater production, or attending sports camp, or a summer police academy for youth might suit your child. Overnight camps where children are immersed in program activities allow more time to bond and share experiences with peers, leading to more opportunities to feel empowered through their achievements.

For a teen who has lost interest in learning, replacing it with ‘hanging out’ and engaging in risky behavior, an exciting academic program could help get him or her back on a positive track. Learning a language abroad or attending a challenging academic summer program at a university could be very valuable. Many outstanding colleges offer fascinating programs that will also enhance your teen’s transcript and help with college admission in the future. Youth conferences and workshops offered by the United Nations or other international organizations can re-direct, inspire, and motivate the child.

Taking a proactive and strategic approach to your child’s summer activities this year, could have a positive impact for years to come.

This week we are going to talk about suicide and self-harm among teenagers. Much attention has been paid lately to the problem of suicide among teens and emerging adults. In my own small New England community, it seems every few weeks there is another report of the death by suicide of a young person. Working with grieving families over the past twenty years, I know well the anguish survivors feel as they cope with the heartbreak of losing a beloved child or sibling to illness or accidental death. For suicide survivors, the loss takes on a whole other level of complexity as families unravel the why and how questions inherent to suicide grief. So, what do you do if you believe your child is at risk? First, take seriously anything your child says or does to indicate she or he plans to self-harm. As the parent of a struggling teen or young adult, you are probably quite familiar with explosive outbursts of anger or periods of complete withdrawal and isolation. During these episodes, your child may be more prone to act on suicidal impulses. It is imperative that you not minimize the dire consequences of your child’s potential actions. Second, get help. Immediately. Do not be tempted to wait it out even if your child recants statements made about hurting her or himself. Your child needs to know you take this seriously. If you have access to mental health resources, mobilize them. Call your child’s therapist and ask for advice about how you can keep your child safe. You can also call the National Suicide Prevention Lifeline (http://www.suicidepreventionlifeline.org) at 1-800-273-TALK (8255). Do not be afraid to call 911 or to transport your child to your local emergency room. Emergency departments are open 24 hours a day, 365 days a year. Most have trained staff who are skilled at evaluating suicide risk. For tips on dealing with an emergency room visit, the Substance Abuse and Mental Health Services Administration (SAMHSA) has published the following excellent brochure: http://store.samhsa.gov/shin/content//SMA08-4357/SMA08-4357.pdf Remember, you are not alone. We have been in your shoes and have come out on the other side. Recovery is not only a dream it is a real possibility. Questions or comments about this topic? Let’s talk. Kathleen http://www.changingtide.net